Disparities – Connecticut Health Investigative Teamhttp://c-hit.org
In-depth Journalism on Issues of Health and SafetySat, 17 Nov 2018 12:58:17 +0000en-UShourly1https://wordpress.org/?v=4.9.8Outreach Programs Target Asthma Hot Spots, But More Help Is Neededhttp://c-hit.org/2018/11/14/outreach-programs-target-asthma-hot-spots-but-more-help-is-needed/
http://c-hit.org/2018/11/14/outreach-programs-target-asthma-hot-spots-but-more-help-is-needed/#respondThu, 15 Nov 2018 02:59:11 +0000http://c-hit.org/?p=340723Robert Carmon had a rough start to life. Shortly after birth he developed asthma, a chronic disease that causes inflammation in the lungs and difficulty breathing. His attacks were so severe as an infant that his parents rushed him to the emergency room practically every week. They were terrified he might die.

Today, at age 7, Robert’s asthma has stabilized. With the help of his dad, Chaz Carmon, he inhales a steroid-based medicine each morning and evening, and he carries a rescue inhaler in his backpack in case an asthma attack comes in school or elsewhere.

Steve Hamm Photo.

Robert Carmon, and dad, Chaz demonstrate the inhaler used twice daily to control Robert’s asthma.

Robert is a bright and energetic child, yet he’s not able to play organized sports because of his asthma. “It’s hard on him,” says his father. “I just hope he grows out of it.”

Asthma, one of the most widespread chronic conditions in the United States, afflicts approximately 26.5 million people nationwide, or about 8.3 percent of the population. The cause is not known and there is no medical cure. The disease disproportionally affects people who live in economically disadvantaged urban neighborhoods. In New Haven’s Newhallville and Dixwell neighborhoods combined (the Carmons live in Newhallville), an estimated 17 percent of residents report asthma, more than double the national rate, according to the Community Alliance for Research and Engagement (CARE).

Connecticut’s asthma rate is worse than the nation’s. It’s 11 percent for children and 10.5 percent for adults—and rising. Neighborhoods in Bridgeport, Hartford and New Haven are among the hardest hit. Automobile exhaust, cigarette smoke and mold and vermin in sub-standard housing are among the triggers. “Your ZIP Code matters. It’s a determinant of health,” said Marie-Christine Bournacki, coordinator of the asthma program for the Connecticut Department of Public Health.

In Hartford’s North Meadows neighborhood, for instance, asthma in children from birth to age 4 accounted for 1,738 visits to hospitals per 10,000 residents in 2016, according to DataHaven. In comparison, the rate in Madison, a wealthy coastline town, was just 78. The median household income in Madison is $108,231; while in North Meadows it’s $20,434.

Leaders of government and health care say the key to making progress in working class neighborhoods is to focus more effectively on some of the medical, social and environment factors related to the disease, and to better coordinate society’s responses. Dr. Beverley Sheares, associate professor of pediatrics at Yale School of Medicine, said: “In these settings, asthma is a symptom of what it means to live in poverty so really you have to change the lives of poor people.”

The EmergencyDepartment

When children suffer severe asthma attacks, their parents often take them straight to the emergency department (ED) of the nearest hospital. That’s the right thing to do, say emergency medicine physicians, because it’s difficult for parents to gauge the seriousness of an attack.

At Connecticut Children’s Medical Center in Hartford, emergency physicians treat from 1,500 to 2,000 children per year for moderate to severe asthma. Guidelines for treating asthma in the ED are well established, and the liquid steroid medications they administer stay in the body for up to 72 hours, making it less likely that kids will suffer another attack right away.

In the past year, Connecticut Children’s introduced a new process for treating patients more quickly—by having nurses engage with them soon after they arrive. Previously, it took an average of 75 minutes to treat asthma patients. Now it’s 34 minutes—and the goal is 20. “Kids come in struggling to breathe. To be able to immediately treat them and see a quick turnaround is pretty amazing,” said Eric Hoppa, a pediatric emergency attending physician at Connecticut Children’s.

But emergency physicians say more effective treatment of asthma in the ED is not the long-term solution to the problem. EDs can stabilize people and provide instructions on how to use inhalers and other medications, but they can’t follow them home to monitor their health, to make sure they’re using inhalers correctly, or to spot asthma triggers in the home. That’s why neighborhood clinics and outreach programs are so important.

Economically disadvantaged people typically seek care at community health centers, and Connecticut has a strong network of centers operating in 38 cities and towns. Recently, some of the centers have begun establishing specialized asthma clinics so they can spot the disease earlier, treat it more consistently, and help patients manage it over the long term.

In New Haven, Fair Haven Community Health Care opened its new Respiratory, Airway and Allergy Clinic (RAAC) in June. It’s staffed by a physician who is certified in treating allergy and asthma, an occupational health specialist, a nurse and a care coordinator who investigates the social determinants of each patient’s asthma. The goal is to help them make adjustments in their lives that will reduce triggers. All of the health center’s patients diagnosed with asthma, and those who show signs or symptoms, are referred to the clinic, which is one of a few of its type in greater New Haven.

Asthma can impact children’s lives catastrophically. “If they’re not treated properly, they miss a lot of school; they sit at home and play electronic games and don’t socialize; and they don’t go outside to exercise and get fresh air,” said Dr. Pamela Kwittken, the physician at Fair Haven’s RAAC clinic.

That’s why it’s essential for children in particular to have asthma action plans. These take-home documents describe the treatment the patient requires routinely and what to do if they experience a severe attack. Fair Haven began routinely creating action plans 1½ years ago and now more than 50 percent of the childhood asthma patients have them.

The next step for the Fair Haven clinic is forging a formal partnership with Milford Health Department’s Putting On Airs, part of Connecticut’s home asthma education program, which helps asthmatics and their families follow action plans and reduce the triggers in their homes.

Under Putting On Airs, teams of health workers conduct a series of three home visits with asthma sufferers. The teams typically include a health educator, who makes sure inhalers and other medications are being used properly, and an environmentalist, who looks for dust-mite-infested carpets, moldy bathrooms, mice and cockroaches.

Recently, the regional team at the Stratford Health Department, which runs Putting on Airs for much of Fairfield County, added a third member—a community health worker. Two other health districts elsewhere in the state will follow suit in the coming months.

The community health worker on the Stratford team, Millie Seguinot, helps translate between English and Spanish during home visits, explains the use of inhalers in simple language, and looks for social issues that impact a family’s ability to control the asthma. In addition, she refers families to social service agencies for food and clothing—and helps them make arrangements with their children’s schools.

One Bridgeport family kept canceling appointments with Putting On Airs. Language was an issue. Seguinot visited the mom on her own and learned that she didn’t understand the asthma action plan nor how to administer medications for her daughter on a regular basis. After Seguinot explained things carefully and helped with scheduling, the mom was able to follow the plan and became more comfortable with additional visits from the team. “It’s important to have somebody that these families can relate to. It might be language, culture, ethnicity or even physical appearance,” Seguinot said.

Better Housing

One of the reasons for Connecticut’s high rate of asthma is that much of the urban housing stock is more than a century old, and many urban people live in rentals (72 percent in New Haven). Old buildings tend to harbor asthma triggers, such as mold and dust mites, and landlords are often reluctant to replace carpets where dust mites hang out, or to repair faulty exhaust fans.

It’s not feasible to replace all of the substandard housing, but with advice from the Putting On Airs teams and support from city health departments and doctors, people can pressure their landlords to improve conditions.

Alice Rosenthal, staff attorney for the Center for Children’s Advocacy, recounts a success story in New Haven that provides a blueprint for others. A 12-year-old boy with severe asthma lived with his mom and two siblings in a rundown apartment where grimy old carpets covered the floors. His mom vacuumed the carpets frequently and even paid to have them steam cleaned, but it wasn’t enough. She asked repeatedly for the landlord to remove them. No go.

Finally, after the boy’s primary care doctor, a pulmonologist and Rosenthal wrote letters urging the landlord to take action, he did so. “Now, the boy is not missing school and, because he’s healthier and using less steroids, he can get outside and play sports,” Rosenthal said. Plus, because the mom doesn’t have to be at home all the time, she’s now working—and the family is doing much better economically.

There’s no magic bullet for addressing asthma, or poverty either. For now, government and health care leaders agree, the key is increasing awareness of what can be done to prevent asthma attacks or respond to them. With adjustments in living situations and proper health care, asthma doesn’t have to keep kids—and their parents—living in misery and fear. They can all breathe easier.

Graphic by Marie K. Shanahan

Please note: At the time of the publication of 2016 Community Health Needs Assessments, the DataHaven analysis of hospital encounter data was only available for certain towns and zip codes, while other data are available for towns statewide or by region.

]]>http://c-hit.org/2018/11/14/outreach-programs-target-asthma-hot-spots-but-more-help-is-needed/feed/0ER Visits For Children In Crisis Up 20% Over Two Yearshttp://c-hit.org/2018/11/01/er-visits-for-children-in-crisis-up-20-over-two-years/
http://c-hit.org/2018/11/01/er-visits-for-children-in-crisis-up-20-over-two-years/#respondThu, 01 Nov 2018 14:05:26 +0000http://c-hit.org/?p=335485The number of Medicaid-insured children treated in Connecticut emergency rooms for behavioral health crises rose 20 percent between 2014 and 2016, mirroring a national trend – despite efforts to provide non-ER treatments.

Most of the children who go to emergency rooms with behavioral health issues go to one of five hospitals, according to data collected by consultant Beacon Health Options, which manages behavioral health care for the state’s Medicaid population.

The 7-day readmission rate at Connecticut children’s was 9 percent in 2016.

After those 2016 ER visits, the study reported, 10.4 percent of youths were readmitted to the ER within seven days, and 25.6 percent were readmitted within 30 days.

The study’s authors said this indicated that youth and/or family needs were not met or there were issues with families following up with the services offered after discharge.

Hospital emergency departments are often ill-equipped to handle children experiencing behavioral health crises. Those children may benefit more from treatment at community mental health centers, schools or a pediatrician’s office, the report’s authors wrote.

“Emergency departments are not really set up from physical standpoint or from a staffing standpoint to be a primary care behavioral health treatment center,” said Jeff Vanderploeg, the president and CEO of CHDI.

Many of the children did not have a follow-up appointment within a month of their initial trip to the emergency room, the study reported.

The report’s authors reviewed several studies of both nationwide trends and the data from individual hospitals, including one that showed emergency room visits for publicly-insured patients under age 18 experiencing psychiatric problems rose 26 percent from 2001 to 2010.

A 2014 national study cited in the report showed the numbers of psychiatric emergency room visits for children covered by private insurance declined during the same period.

In Connecticut, the 2012 Sandy Hook school shooting prompted state officials to try to reduce behavioral health emergency room visits with initiatives to increase the number of crisis-stabilization beds, create Behavioral Health Assessment Centers and redirect children with autism spectrum disorders to specialized services.

The report’s authors said some of those efforts have been effective, singling out the state’s Mobile Crisis Intervention Service hotline as a “critical alternative” to the ER that parents, guardians and teachers can call to request a clinician who will treat the child at their home or school.

“We have one of the best behavioral health systems for children in the country … and we’re still seeing a large number of children showing up to emergency departments for treatment,” Vanderploeg said.

The report said nearly 1,300 Medicaid-insured children in 2016 were “stuck” in the emergency room after a behavioral health crisis, staying in the hospital for days or weeks before they were discharged, according to the data.

At Yale, the 7-day readmission rate was 10.1 percent.

And about 35 percent of those children did not have a follow-up appointment to see a behavioral or mental health professional in the month after they went to the emergency room. Vanderploeg said that number could indicate poverty, lack of transportation or poor coordination between behavioral health providers are preventing parents and guardians from taking children to mental health appointments.

A CHDI working group that produced the report concluded that the state should try to alleviate pressure on emergency rooms by promoting collaboration between the hospitals, the state’s mobile crisis program and schools, and try to promote follow-up care at community health organizations for children who have been to the emergency room.

“If someone is coming to the ED and the questions are really about how to manage or treat the individual in an ongoing way … the staff are not necessarily trained or focused on addressing those questions,” said Michael Hoge, the director of Yale Behavioral Health at the Yale Department of Psychiatry and a consultant on the working group. “It raised the question of where else they would go,” said Hoge.

Family members of children with behavioral health concerns said they relied on emergency rooms when the child’s behavior was out of control or when the child had suicidal thoughts, often to get a diagnosis or guidance about how to cope, according to the report.

The working group delivered recommendations for state agencies to lessen emergency room visits and improve access to community-based mental health care, including:

• Fund the placement of care coordinators and family support specialists in high-volume emergency rooms.

• Provide telepsychiatry services connecting behavioral health specialists to emergency room staff, a service already available to pediatricians in Connecticut.

• Appropriate funds for the state Department of Children and Families to create Behavioral Health Assessment Centers that would provide evaluation during behavioral health crises, as well as treatment and referral, for children, youth, and families.

Parents can call 2-1-1 to access Connecticut’s Mobile Crisis Intervention Services if their child or adolescent is having a behavioral health crisis that is too much for them to handle on their own. Mobile Crisis responses 24 hours a day, 7 days a week. Services are confidential, and there is no cost to the family.

]]>http://c-hit.org/2018/11/01/er-visits-for-children-in-crisis-up-20-over-two-years/feed/0Midwives Could Be Key To Reversing Maternal Mortality Trendshttp://c-hit.org/2018/10/30/midwives-could-be-key-to-reversing-maternal-mortality-trends/
http://c-hit.org/2018/10/30/midwives-could-be-key-to-reversing-maternal-mortality-trends/#respondWed, 31 Oct 2018 02:07:19 +0000http://c-hit.org/?p=334338The Connecticut Childbirth & Women’s Center in Danbury is a 50-minute drive from Evelyn DeGraf’s home in Westchester. Pregnant with her second child, the 37-year-old didn’t hesitate to make the drive—she wanted her birth to be attended by a midwife, not a doctor.

DeGraf believed midwifery care to be more personal and less rushed than that delivered by obstetrics/gynecologists (OB/GYNs). She also knew an OB/GYN would deem her relatively advanced maternal age and previous cesarean section history too high-risk to attempt a VBAC, or vaginal birth after cesarean section.

But she had to drive roughly 35 miles to find a midwife because there aren’t many of them.

Despite the fact that an estimated 85 percent of women are appropriate for midwife care, midwives attend about 11 percent of births in Connecticut, said Holly Kennedy, professor of midwifery at Yale School of Nursing. By contrast, about half of all babies in England are delivered by midwives, according to National Health Services statistics. Kennedy sees a direct correlation between lower use of midwives and higher maternal mortality.

“If you scaled up midwives, you would avert over 80 percent of maternal deaths,” Kennedy said. In Connecticut, there are 211 licensed nurse-midwives, compared to 945 licensed OB/GYNs, according to state Department of Health records. Unlike some other states, which employ midwives who do not require nursing degrees, Connecticut recognizes only nurse-midwives, who hold advanced degrees in nursing and additional training in midwifery.

Babies born to black women are more than twice as likely to die in the first year of life than babies born to white women, and black women are 243 percent more likely than white women to die from pregnancy-related complications, according to the Centers for Disease Control and Prevention.

DeGraf’s second child was born vaginally at Danbury Hospital, assisted by a nurse-midwife employed by the Connecticut Childbirth Center. Her low-intervention delivery is common of births attended by midwives who, statistically, use fewer intervention than physicians during labor and delivery.

Cesarean sections, considered major surgery, carry well-established risks: higher rates of hemorrhage, transfusions, infections, and blood clots—all primary causes of maternal mortality, whose rates increased nationwide (with the exception of California) by 26.6 percent between 2010 and 2014, according to a study supported by The National Center for Biotechnology Information.

Melanie Stengel photo

Caroline Dicolla of Ridgefield, at left, gets some help bundling up her infant daughter, Kohana Domejczyk, from midwife Cathy Parisi after Dicolla’s appointment the Connecticut Childbirth & Women’s Center in Danbury.

Midwives are also linked to higher rates of physiologic birth and fewer adverse neonatal outcomes, according to a nationwide 2018 study, which ranked states by how well midwives are integrated into regional health care systems. Connecticut fell into the bottom third. Experts say the low ranking is due in large part to a lack of access to midwives. Many would-be nurse-midwives never get the chance to train for the position in Connecticut.

“At Yale, I get at least 100 applicants for our [nurse-midwife] program. Most are highly qualified, but I can only accept 25 percent,” said Kennedy, an author of the 2018 study. She explained that most federal health education dollars are directed to schools of medicine, thereby limiting resources for midwifery education, including the ability to reimburse preceptors who oversee clinical training of nurse-midwife students.

Those who do find spots in one of Connecticut’s two nurse-midwife programs (Fairfield University offers a doctor of nursing practice in midwifery) may confront challenges to practicing upon graduation. Many face high debt hurdles, Kennedy says, and search the country for employers willing to repay their student loans. Those who do find jobs in Connecticut may be stymied from practicing to the fullest extent possible.

Cathy Parisi is director at the Connecticut Childbirth & Women’s Center, the state’s only freestanding birth center. She says that while Connecticut legislation authorizes its nurse-midwives to practice to “full scope care,” which includes admitting privileges at hospitals that credential nurse-midwives, not all hospital bylaws reflect current state statutes; therefore, some hospitals in Connecticut do not grant admitting privileges.

“Little things like that are terribly irritating,” said Parisi, who suggested several possible reasons why hospitals wouldn’t allow a nurse-midwife to practice within the full scope of her license, including pressure from physicians, medical staff or the hospital legal department or, simply, resistance to change.

Nurse-midwives follow the same standards of care as OB/GYNs, but the difference in how they deliver care has an increasing number of women gravitating to the midwifery model. The Connecticut Childbirth & Women’s Center, which at its inception about 25 years ago delivered five or six births per month, now facilitates up to 35 per month and has increased its staff accordingly, from two to five full-time nurse-midwives.

Melanie Stengel photo

Midwife Lindsay Lachant lets some light into the birthing room at the Connecticut Women’s & Childbirth Center in Danbury.

One of its patients is 25-year-old Teja Brindisi, a resident of Naugatuck, who switched her healthcare provider halfway through her first of two pregnancies from an OB/GYN practice to the Connecticut Childbirth & Women’s Center. For her second child’s delivery, she had a natural water birth delivery at the center with the aid of a nurse-midwife, an experience she called “amazing.”

It was also affordable, covered by her health insurance to the same extent a hospital birth attended by an OB/GYN would have been. With rare exceptions, all insurances cover midwifery services, including HUSKY/Medicaid, though some plans reimburse midwifery services at 90 percent of the physician rate, said Stephanie Welsh, vice president of the American College of Nurse-Midwives’ Connecticut affiliate.

“We have been fighting the battle for equal reimbursement for many years, and will continue to do so,” Welsh said.

While the cost to patients is typically the same whether they use a nurse-midwife or an OB/GYN, they may feel like they’re getting a better deal with a nurse-midwife.

“By seeing only two to three patients an hour a midwife has time to spend with her client. Physicians simply do not have the time in their schedules to accommodate such lengthy visits for a low-risk woman,” Parisi said. In contrast, their midwife practice schedules only two to three patients per hour.

Physicians may spend less time with patients, but tend to apply medical interventions more readily than nurse-midwives, whose model relies less on medical interventions and more on educating and communicating with patients.

“Midwifery is a relationship-based profession. One of the reasons we probably do have better outcomes is because we listen to women,” Yale’s Kennedy said.

Despite differing perspectives, many midwives and OB/GYNs work together and report a collegial relationship.

“The physicians in my practice are very receptive to midwifery input, and really value our expertise,” said ACNM’s Welsh, who practices at Manchester Hospital with six other midwives and 14 physicians.

John Kaczmarek, an OB/GYN with privileges at St. Mary’s Hospital and Waterbury Hospital, said of nurse-midwives: “I’ve learned a lot from them; for example, we don’t always have to force nature.”

But Kaczmarek was quick to acknowledge the hierarchy within his practice. “[Nurse-midwives] practice independently but know their limitations,” he said.

“They know when to call for physician help.”

That may be true, but when it comes to compassionate care, midwives seem to know no limits. “With the midwives, I felt more taken care of,” Westchester’s DeGraf said.

No amount of fame or fortune can run interference when it comes to mothers dying or at-risk during pregnancy, childbirth, or early motherhood. And that holds especially true for African American women.

The World Health Organization defines maternal mortality as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy” not from accidental or incidental causes. Worldwide, 99 percent of women who die during or after childbirth live in developing countries. Skilled care before, during, and after pregnancy are a proven deterrent.

In Connecticut, between 2011 and 2014, the official count for pregnancy-related deaths is 8. There are no more recent numbers, and that number is inaccurate. Maternal deaths have been woefully underreported, with scant attention paid to racial breakdowns. Connecticut was, however, included in a 2017 study that looked at 27 states and the District of Columbia. The report said that between 2013-2014, there were just over 56 maternal deaths for every 100,000 births among African American mothers, compared to just over 20 for white mothers.

iStock Photo.

In CT, the official count of pregnancy related deaths is 8 from 2011-2014. There are no more recent numbers.

Maternal deaths are tied to multiple factors, including poverty, access to health care, the health of the mother prior to pregnancy, as well as less easily-identified reasons. A recent California survey said doctors tend not to listen to African American women as carefully as they do white women. When her daughter Alexis Olympia was born last September by emergency C-section, tennis great Serena Williams had to ask twice for a CT scan. (A nurse thought the tennis great was loopy from pain medicine.) When her medical team finally listened to Williams’ suggestion, the scan revealed blood clots in her lungs. Later, her C-section burst open, and the complications nearly grounded her.

The crisis has been building, but only recently have elected officials started to take notice. Earlier this month, a bipartisan group of U.S. Senators asked the White House to commit to reducing maternal mortality. The group includes 14 senators, including Lisa Murkowski (R-Alaska); Cory Booker (D-New Jersey); and both senators from Florida, Bill Nelson, a Democrat, and Marco Rubio, a Republican. The senators asked for more data, particularly around women living in poverty who receive government aid.

Also earlier this month, after a USA Today investigation into the phenomenon, the powerful House Ways and Means Committee sent letters 15 hospitals chains, asking them for information about the deaths of new mothers in their care, as well as how they identify at-risk women, the number of deliveries they performed in 2017, and information about pregnancy-related deaths of women in their care. The hospital chains operate 900 hospitals around the country.

Add to that some private initiatives, including a grant program from Merck & Co., a pharmaceutical company that announced plans to give $500 million to city-based organizations that work to reduce maternal mortality.

Unfortunately, this program isn’t state-funded, either. In the face of this health crisis, an unfunded program feels like lip service. The next session starts in January. Let’s see if Connecticut’s legislators can take another, serious look at this. Research takes funding. Collecting data does, as well.

Susan Campbell is a distinguished lecturer at the University of New Haven. She can be reached at slcampbell417@gmail.com.

]]>http://c-hit.org/2018/10/23/u-s-maternal-mortality-rate-is-disgraceful-worse-for-women-of-color/feed/0Health Insurance Open Enrollment Begins Nov. 1; You Can Window Shop Starting Todayhttp://c-hit.org/2018/10/22/health-insurance-open-enrollment-begins-nov-1-you-can-window-shop-starting-today/
http://c-hit.org/2018/10/22/health-insurance-open-enrollment-begins-nov-1-you-can-window-shop-starting-today/#respondMon, 22 Oct 2018 12:52:09 +0000http://c-hit.org/?p=330722Consumers will have the shortest open enrollment period yet to shop for 2019 health insurance plans – 45 days — but they can “window shop” and compare plans beginning today.

Open enrollment for health plans effective Jan. 1, 2019, will run from Nov. 1 to Dec. 15, giving consumers the least amount of time to enroll in or renew plans since the Affordable Care Act (ACA) became law. Last year, consumers had an additional week.

As a result, Access Health CT (AHCT), Connecticut’s health insurance exchange, is broadening its outreach and marketing efforts and, for the first time, giving consumers a sneak peek at plans.

“A lot of people want to see what options they have ahead of open enrollment,” said AHCT Marketing Director Andrea Ravitz. “Every year, we need to remind individuals that they have choices. We want to make sure they have access to as much information as possible to pick the right plan.”

This year’s marketplace offers plans from ConnectiCare and Anthem. Open enrollment is Nov. 1-Dec. 15.

Consumers can browse plans starting today using a special tool at accesshealthct.com. In addition, AHCT is holding a series of events across the state and offering phone, online and in-person assistance to help individuals choose a plan.

The average ACA monthly premium cost was $689 this year, but for 75 percent of enrollees the average subsidy was $600, according to a report from the Centers for Medicare & Medicaid Services.

The marketplace has two insurance carriers, ConnectiCare and Anthem. Many plans offered for 2019 under both carriers will cost more, but in September state regulators drastically reduced the rate hikes both carriers had sought.

Anthem had proposed a 9.1 percent rate increase for 2019 plans, but regulators approved an average premium increase of 2.7 percent. ConnectiCare had sought a 13 percent increase, which was pared down to an average increase of 4 percent.

As in the past, plans are organized into bronze, silver, gold and platinum categories, and consumers should compare plans to see what works best for them. Platinum plans, for instance, typically have higher premiums but lower out-of-pocket costs, whereas bronze plans have the lowest premiums but highest out-of-pocket costs.

No ‘Opt Out’ Fines

One big change consumers will notice for 2019: There will be no financial penalty for opting not to buy insurance.

In previous years, most consumers had to have insurance or face a fine. Those who had no insurance in 2018 will pay either 2.5 percent of their yearly household income or $695 per person ($347.50 per child), whichever is higher, when they file their 2018 tax returns in early 2019.

Ravitz said AHCT conducted focused groups with about 60 individuals to gauge whether the absence of a penalty would impact enrollment trends for 2019.

“The majority said, with or without the tax penalty, it wouldn’t affect their decision,” she said.

The Marketplace

AHCT is the online marketplace created by the ACA, sweeping health care reform legislation that requires most Americans to have health insurance.

During open enrollment, people without coverage can shop for insurance plans and those with coverage can renew or change their plans.

Ravitz said it is too soon to predict how many people will enroll in plans through the exchange this year, but 114,134 did last year, up more than 2 percent from the previous year. Of those, most—about 73 percent—enrolled in plans offered by ConnectiCare.

Various improvements have been made to AHCT’s website, including enhanced live chat capabilities and a new “Compare Plans” link that will let consumers see various plans’ physician networks, prescription coverage, out-of-pocket expenses and other benefits, Ravitz said.

“This is going to allow people to make better, more informed choices,” she said of the comparison tool. While monthly premium costs often play major roles in which plans consumers choose, she added, “We want to make sure people are able to make better decisions rather than just looking at the price tag.”

After open enrollment ends on Dec. 15, consumers can sign up for 2019 coverage only if they have a qualifying life event, such as loss of insurance, marriage or the birth of a child. New this year, pregnancy is now a qualifying life event.

Consumers can apply online, call AHCT at 855-805-4325, get in-person help, or use AHCT’s free mobile app for smartphones or tablets.

While most people have to wait until Nov.1 to enroll in plans, enrollment in Medicaid HUSKY and the Children’s Health Insurance Plan (CHIP) is open year-round to eligible people and families.

AHCT, now in its sixth year, also will open seven enrollment centers statewide in early November where people can receive in-person help, and will host six enrollment fairs. In addition, it will host a traveling series of educational discussions called “Healthy Chats,” during which experts will speak to groups of people about enrollment options as well as answer questions.

Usually, some people—about 15 percent of those who enroll in plans through AHCT—have trouble verifying the income or citizenship information they must submit once the open enrollment period ends, Ravitz said. AHCT is increasing efforts to reach and help those people too, she added.

]]>http://c-hit.org/2018/10/22/health-insurance-open-enrollment-begins-nov-1-you-can-window-shop-starting-today/feed/0HPV-Related Cancer Rates Outpace Vaccine Rateshttp://c-hit.org/2018/09/18/hpv-related-cancer-rates-outpace-vaccine-rates/
http://c-hit.org/2018/09/18/hpv-related-cancer-rates-outpace-vaccine-rates/#respondTue, 18 Sep 2018 12:27:25 +0000http://c-hit.org/?p=314680Cancers linked to the human papillomavirus (HPV) rose dramatically in a 15-year period, even as the rates of young people being vaccinated climbed, the Centers for Disease Control and Prevention (CDC) reported.

The 43,371 new cases of HPV-associated cancers reported nationwide in 2015 marked a 44 percent jump from the 30,115 cases reported in 1999, according to a CDC analysis.

HPV vaccination rates have improved over the years, but not fast enough to stem the rise in cancers, the CDC said.

Oropharyngeal (throat) cancer was the most common HPV-associated cancer in 2015; accounting for 15,479 cases among males and 3,438 among females, the CDC data show.

iStock Photo.

In Connecticut, 58.4 percent of girls age 13 to 17 and 37.8 percent of boys received three doses of HPV vaccine.

HPV infects about 14 million people each year and between 1999 and 2015 rates of oropharyngeal (throat) and vulvar cancer increased, vaginal and cervical cancer rates declined, and penile cancer rates were stable, according to the CDC.

“The [overall rise] seems to be mostly driven by oropharyngeal cancers,” said Dr. Sangini Sheth, assistant professor of obstetrics, gynecology and reproductive sciences at Yale School of Medicine.

“Vaccination is key to preventing those cancers,” said Sheth, who also is an associate medical director and director of colposcopy and cervical dysplasia at Yale New Haven Hospital’s Women’s Center.

“Oropharyngeal cancer is most common in men, and HPV vaccination rates, while they are rising in the U.S. and Connecticut, became routine for boys later [than girls]. And the rate of vaccinations among boys has definitely lagged that of girls. Hopefully, we will see vaccinating our boys have an impact on oropharyngeal cancer, but that’s going to take time.”

The push to vaccinate adolescents against HPV is a relatively recent development. The vaccination was included in the routine immunization program for females in 2006 and for males in 2011, according to CDC.

At one time, the HPV-vaccine was viewed largely to prevent sexually transmitted diseases, and some parents “resented” it and thought it was unnecessary for their children, according to Dr. Richard Brauer, section head of otolaryngology at Greenwich Hospital.

Now it’s marketed as a cancer vaccine and parents have become more receptive, said Brauer, who also has a private practice, Associates of Otolaryngology, in Greenwich.

In 2017, 65.5 percent of adolescents aged 13 to 17 nationwide had at least one dose of the HPV vaccine, up 5.1 percentage points from 2016, according to CDC data released in August.

In Connecticut, 75.4 percent of girls aged 13 to 17 had one dose of the vaccine, 67.1 percent had two doses and 58.4 percent received three doses. Among males, 67.3 percent received one dose, 58.8 percent got two and 37.8 percent got three, the 2017 data show.

But even amid overall gains, hurdles remain: gender disparity persists, and many teens received the first vaccine dose but failed to get necessary subsequent doses.

Children who are 11 or 12 years old should get two shots of HPV vaccine six to 12 months apart, according to the CDC. Adolescents who get their shots less than five months apart need a third dose of the vaccine, as do all children older than 14. Three doses also are recommended for people ages nine to 26 who have certain immunocompromised conditions.

“It falls on the parent” whether children get vaccinated, said Dr. Bradford Whitcomb, chief of gynecologic oncology at UConn Health. “People associate HPV with female stuff. It needs to be pushed that we’re not just preventing female cancers.”

While it’s encouraging that vaccination rates are climbing, “we just may not see the benefit of that for years to come,” Whitcomb said. “It’s going to take a longer time, especially with the development of cancer, to see the effect. After the HPV infection, it can take years for a cancer to develop.”

Many people exposed to HPV will never get cancer, doctors say.

The most common HPV-associated cancer among women is cervical cancer. Data show rates of that cancer are falling, but there are racial disparities.

Between 2011 and 2015, Hispanic women had the highest incidence rates of cervical cancer at 8.9 percent, according to an analysis by the Kaiser Family Foundation. That compares with 8.4 percent among black women, 7.4 percent among white women and 6.1 percent among Asian and Pacific Islander women.

It is crucial for doctors to talk to young patients and their parents about the HPV vaccine, even if it spurs conversations parents may feel awkward having, Sheth said.

“Clinicians need to feel comfortable normalizing the HPV vaccine and really present the HPV vaccine as a cancer prevention tool,” she said.

]]>http://c-hit.org/2018/09/18/hpv-related-cancer-rates-outpace-vaccine-rates/feed/0Strategic Outreach Bridging Racial Gap In Pregnancy-Related Health Outcomeshttp://c-hit.org/2018/08/07/strategic-outreach-bridging-racial-gap-in-pregnancy-related-health-outcomes/
http://c-hit.org/2018/08/07/strategic-outreach-bridging-racial-gap-in-pregnancy-related-health-outcomes/#respondWed, 08 Aug 2018 01:02:54 +0000http://c-hit.org/?p=295143New Haven resident Kimberly Streater was pregnant with her third of six children when she called her friend for a ride to the hospital after sustaining a hit to her stomach by her then-husband.

When she reached the hospital, Streater, not yet 28 weeks pregnant, alerted personnel that her baby was coming—now. “They said, ‘No, no, he’s not coming,’ after I told them he was,” she recalled. Minutes later, Howie was born at 3 pounds and 1.5 ounces in the admitting area of the hospital, just as Streater had predicted.

Statistically, the preterm birth of Streater’s baby does not come as a surprise. In Connecticut and nationwide, black women and their infants suffer disproportionately worse pregnancy-related health outcomes than white women.

Carl Jordan Castro Photo

Kimberly Streater with her son Howard Lewis, 18, in her office in New Haven.

The March of Dimes’ 2017 Premature Birth Report Card for Connecticut revealed that between 2013 and 2015, 8.4 percent of all (live birth) infants born to white women were premature, compared with 12.4 percent of infants born to black women. Statewide, after a complication-free delivery, black women are twice as likely as white women to be readmitted to a hospital within 30 days, according to a 2015 study published in the journal Obstetrics and Gynecology, which drew from statistics maintained by the Connecticut Department of Public Health.

These racially disparate outcomes mirror persistent racial gaps nationwide. Babies born to black women are more than twice as likely to die in the first year of life than babies born to white women, and black women are 243 percent more likely than white women to die from pregnancy-related complications, according to the Centers for Disease Control and Prevention.

These statistics aren’t new. What’s new is how some professionals throughout Connecticut—from psychiatric researchers to community activists to medical doctors and progressive health centers—are reframing the way racial disparities are addressed: by re-examining their root causes and coming up with new solutions. This close examination of racial disparities in pregnancy-related outcomes coincides with a recent push to address the nation’s discouraging overall maternal death rates, which increased by more than 25 percent between 2000 and 2014, while those in other developed countries declined, according to a study published in the journal Obstetrics and Gynecology.

New Haven Healthy Start (NHHS), a community-based program, has been working for three decades to identify and eliminate racial disparities in birth outcomes. The organization has examined several factors as possible culprits in the racial divide, including poverty, health insurance, and access to prenatal care. Ultimately, they homed in on one factor.

“Racism. Discriminatory practices based on race. That’s what we’ve been focusing on,” said Kenn Harris, president of the board of directors of the National Healthy Start Association and project director at NHHS. In response, they offer a program where women, regardless of their race, feel truly supported throughout their pregnancy.

Meeting Moms Where They Are

At the heart of NHHS’s simple yet highly effective strategy is its care coordination service model, recruited from places including libraries, laundromats and beauty salons within the communities they serve. They do outreach at strategically located places where pregnant women in the program’s target population are likely to visit, including community health centers and homeless agencies. Every participant is assigned a care coordinator, who provides an array of support—from helping them sign up for state Medicaid to arranging transportation and childcare to reaching out to them if they miss a doctor appointment.

The key to these care coordinators and other employees at NHHS? They look like the women they serve, and, in many cases, they’ve been through similar situations. Natasha Ray, a 49-year-old resident of East Haven, had her first of four children at 16; all her infants were born premature. Now she’s the core service manager at NHHS.

“My interest in the program was personal. Here was a program whose focus is on prematurity, health disparities and strengthening the fragmented system that families must navigate. I feel that this was an opportunity to be the person for so many mothers-to-be that I did not have. When you know better, chances are you will do better,” Ray said.

The approach works. In 1987, one in every 50 infants born in New Haven died in the first year of life. Today, only one out of every 222 infants whose mothers are enrolled in NHHS dies in the first year of life, according to the Community Foundation for Greater New Haven, which runs the Healthy Start program in New Haven. In 2017, 1,402 women were enrolled in NHHS. Of these, 43 percent were black, 38.5 percent were mixed race, 16 percent white, and 2.5 percent Asian.

Another program making a difference in the health of black moms is The New Haven MotherS (MOMS) Partnership. This community–academic partnership, founded in 2011 by Yale associate professor of psychiatry Megan Smith, DrPH, MPH, seeks to improve maternal mental health among low-income women through a community-driven approach.

“We know that depression co-occurs with trauma and anxiety disorders, particularly post-traumatic stress disorders, and that they can increase a woman’s chance of preterm birth,” said Smith, who is also the program’s director.

Smith said she started the MOMS partnership because of increasing racial inequities she observed related to mental health care among New Haven residents. “They’re more likely to drop out of mental health care programs, and less likely to receive high quality mental health care,” Smith said of the women targeted by the MOMS partnership. Since its inception, the program has reached more than 500 low-income moms and pregnant women from New Haven, about 70 percent of whom are women of color.

The program provides outreach to mothers and pregnant women in targeted neighborhoods of New Haven, requesting that they complete mental health assessments. Those who demonstrate need receive cognitive behavioral therapy in familiar settings, including the second floor of the city’s Stop & Shop grocery store and other citywide locations. The treatment setting is non-threatening; so too are the community mental health ambassadors (CMHAs), employees who recruit participants and accompany them to treatment.

CMHAs are mothers from the local community trained to focus on target population outreach and, when deemed necessary, to support mental health treatment. They work alongside traditional mental health clinicians. Most possess customer service experience; they all empathize with the participants’ struggles.

Smith attributes the program’s overwhelming success largely to the ambassadors and the community settings where they serve women. To date, over 70 percent of participants registered for cognitive behavioral therapy through the partnership have adhered to treatment, and more than 50 percent report decreased depressive symptoms.

Carl Jordan Castro Photo

Kimberly Streater with her youngest daughter Nevaeh Lewis, 14, and son Howard Lewis.

Streater, who gave birth prematurely to two of her six children, is a CMHA. She learned about the job when taking a free stress management class about five years ago. Streater says she didn’t have much of a support network as a pregnant or new mom. “It was pretty much me,” she said.

Implementing simple, common-sense practices within existing healthcare systems also lends support that can help close racial gaps in pregnancy outcomes. At Southwest Community Health Center in Bridgeport, about 80 percent of the patients that advanced practice midwife Janet Spinner sees are women of color. She’s pleased about the decisions the center makes to accommodate its patient population’s health needs. For instance, instead of waiting to see patients at the typical six-week postnatal visit, Spinner has new mothers come for a checkup between one and two weeks after delivery, then again at the six-week mark. “That’s when scary post-pre-eclampsia can rear its ugly head,” Spinner said of the dangerous medical condition that occurs more frequently among black women and can happen during or shortly after pregnancy. Spinner also uses the initial postnatal visit to check in with patients about breastfeeding, social support, and intimate partner violence, which she refers to as “the elephant in the room.” And, Spinner says, the Bridgeport health center provides strong diversity training to its employees, a trend she sees becoming more prevalent throughout the state.

“We really need to talk about this as a community,” she said.

Black women might be more likely to go to the doctor’s office when the doctor looks like them. Marcia Tejeda, MD, a black OB/GYN who works in Waterbury, acknowledges that she probably sees 5 to 7 percent more black patients than the other physicians in her group practice—a choice based on her patients’ preferences.

Although Tejeda says she feels all the physicians with whom she works make a “tremendous effort to give all women excellent care,” she does suggest that, in general, doctors and other medical professionals could benefit from education and training that focuses on how to improve their interactions with black patients, including learning how to better understand their culture and improve ways of communicating with them. Tejeda also proposes that race-specific research initiatives occur more routinely.

“Now that we see the mortality rate is higher for black women, we need to do research that’s specially geared toward black women,” Tejeda said. “That will be the key to decreasing mortality for black women and improving outcomes for their babies.”

]]>http://c-hit.org/2018/08/07/strategic-outreach-bridging-racial-gap-in-pregnancy-related-health-outcomes/feed/0Yale Program Tackles Kids’ Obesity By Teaching Parents Healthy Eating Habitshttp://c-hit.org/2018/07/18/yale-program-tackles-kids-obesity-by-teaching-parents-healthy-eating-habits/
http://c-hit.org/2018/07/18/yale-program-tackles-kids-obesity-by-teaching-parents-healthy-eating-habits/#respondWed, 18 Jul 2018 13:36:14 +0000http://c-hit.org/?p=285198It’s a summer afternoon and parents with their young children have gathered to hear what a nutritionist with Women, Infants and Children (WIC) has to offer.

They watch with intrigue as Mary Paige demonstrates how to make yogurt dots from frozen Greek yogurt and French fries from roasted parsnips and carrots.

“I always buy the [yogurt dots] from Walmart,” she said. “If I can make them myself, even better. And these will be good for teething.”

The five parents who attended the demo are participants in a pilot program that aims to combat childhood obesity. Launched last fall, the program integrates a healthy-eating curriculum into group well-child visits at the Primary Care Center. Leaders expect it to result in slower weight gain among infants as well as healthier mothers and families.

“Obesity is a big problem in our country,” she said. “It is such an issue of health disparity. The numbers are really far worse among people who are living in poverty. Healthy food is expensive, and food that is much more likely to lead to obesity is cheap and easy.”

That’s why the program is partnering with the WIC office, she said. WIC is the federal Special Supplemental Nutrition Program that provides subsidies to low-income pregnant and postpartum women and children up to age 5 who are at nutritional risk.

In 2014, 9.5 percent of WIC-enrolled children in Connecticut between the ages of 3 months and 23 months had high weight for their length, according to data from the Centers for Disease Control and Prevention (CDC). Racial disparities were evident, with a 10.6 percent obesity rate among Hispanic children in that age group, compared with 9.9 percent among blacks and 7.7 percent among whites.

Also in 2014, 15.3 percent of Connecticut WIC participants aged 2 to 4 were obese, according to the CDC. In that age group, 18.2 percent of Hispanics were obese, compared with 12.4 percent of blacks and 12.1 percent of whites. But the obesity rate among 2- to 4-year-olds marked a decrease from recent years, down from 17.1 percent in 2010.

The nutrition component, including cooking demonstrations, is added at well visits, when babies are 3 months, 6 months, 9 months and 1 year old.

“This model is extremely unique,” said Deborah Diehl, manager of the WIC program at the hospital. “Nobody is really doing this in the whole state. Having the nutrition component is critical.”

“One of the goals is to empower families, especially because we’re dealing with people who often feel disempowered in other aspects of their lives,” Rosenthal said. “Thinking about [how to care for your child] and relating that to food made a lot of sense to us.”

When babies are 3 months old, for instance, the group focuses on how parents can eat well to be role models to their children, Paige said. When babies are 6 months, parents learn how to make homemade baby food; and when babies are 9 months old, parents learn how to know when babies are full or hungry, Paige said.

At a recent session for parents of 9-month-olds, the adults—mostly mothers but also a couple of fathers—learned how to introduce peanut butter to their babies by thinning it out with warm water to make it more palatable. They also learned how to read nutrition labels.

Yale’s Primary Care Center, which houses the WIC office, has offered group well-child visits for a decade but the focus on nutrition within the groups is new, Rosenthal said. The center serves only people who are on Medicaid or HUSKY, she said.

For Uriostegui, the process has been eye-opening. “It’s benefiting all of us,” she said. “Today I just learned a new vegetable [parsnip] I never heard of before. I’m gonna try it. We’re learning new ways to introduce babies to new foods.”

In addition to Yale’s program, the University of Connecticut’s Rudd Center for Food Policy and Obesity received $64,998 to study barriers to participation in the federal Child and Adult Care Food Program, and UConn’s Allied Health Sciences received $64,982 to develop a program for communicating with low-income parents in East Hartford about best practices for feeding toddlers.

]]>http://c-hit.org/2018/07/18/yale-program-tackles-kids-obesity-by-teaching-parents-healthy-eating-habits/feed/0Poor And Minority Women Face Widening Barriers To Depression Treatmenthttp://c-hit.org/2018/07/02/poor-and-minority-women-face-widening-barriers-to-depression-treatment/
http://c-hit.org/2018/07/02/poor-and-minority-women-face-widening-barriers-to-depression-treatment/#respondMon, 02 Jul 2018 12:15:38 +0000http://c-hit.org/?p=280876Among women, those who are low-income or minority are less likely to get treatment for depression, according to multiple studies.

A report by the Connecticut Behavioral Health Partnership found that women were underrepresented in Medicaid-funded behavioral health services in the state even though research shows that women suffer from the most commonly diagnosed mental health disorders more frequently than men.

Racial and ethnic disparities, while still considerable, are decreasing in some physical illnesses. “But in mental health care, in the last 10 years, we see those disparities widening,” said Megan Smith, associate professor in the Departments of Psychiatry and in the Child Study Center in the Yale School of Medicine, who runs the Mental health Outreach for MotherS (MOMS) Partnership®, a program that offers mental health services to “overburdened and under-resourced mothers.”

In this podcast, sponsored by ConnectiCare, Colleen Shaddox discusses the hurdles to mental health care and the programs breaking barriers to care with Yale’s Megan Smith and UConn Health’s Dr. Sarah Nguyen.

Lack of insurance coverage, the cost of treatment, a shortage of qualified clinicians, stigma and even fear of losing custody of their children can keep women from seeking help, Smith said. Blacks and Hispanics are more likely to report psychological distress than non-Hispanic whites, and the rates increase dramatically for minorities who live in poverty, according to the Centers for Disease Control and Prevention. But white women are using mental health services at more than twice the rate of black or Hispanic women, data from the federal Substance Abuse and Mental Health Services Administration show.

“Unfortunately, lack of health insurance is often the biggest barrier to receiving care for depression. And with the lack of insurance there are financial barriers that come into play,” said Dr. Sarah Nguyen, a psychiatrist and faculty member at the University of Connecticut School of Medicine.

Yale School of Medicine Photo.

Megan Smith, associate professor in the Departments of Psychiatry and Child Study Center, Yale School of Medicine.

More than 42 percent of adults who do not get needed mental health treatment said they cannot afford it, according to the National Survey on Drug Use and Health. Medicaid does not reimburse clinicians for the full cost of mental health treatment, creating a shortage of providers who accept Medicaid. A 2015 study found that Connecticut clinicians experience a $27 million annual loss versus standard fees when providing mental health care under Medicaid.

There is also a shortage of clinicians who are minorities. “I think it goes back to increasing the human capital in the mental health field,” Smith said. “What I mean by that is really increasing the training and the availability of providers who are of racial and ethnic minority background themselves, and of providers who accept Medicaid and sliding scale, and, particularly, providers who are using evidence-based treatments. We know we have to be concerned about the quality of care, and so we want to, of course, lift up the quality of care that everyone receives.”

And then there is stigma, which is blamed for keeping people out of treatment regardless of background. Research shows that pressure to be “a strong woman” and a reliance on faith communities and other sources outside of health care providers discourage black women from seeking depression treatment.

Women who use the MOMs program often do not even use the word depression. “Stress is actually the way that many mothers we talk to describe depression,” Smith said. “So, mothers will talk about stress and really mean anxiety, trauma, addiction, depression.”

Women can access MOMs services at places like the laundromat. They can even get therapy at the local Stop & Shop. “The feedback we have from mothers on that is excellent,” Smith said. “They really like receiving care there. They feel safe. They feel secure, and it really feels like part of the community.”

One day a week Nguyen practices in a primary care center and sees patients she says would never have come to her psychiatry office to begin therapy. “Once I’ve established a rapport and a relationship with [patients] they’re more open to seeing me in other clinics,” she said.

Being in the primary care clinic is a particularly good way to get immigrant women into treatment, Nguyen added, because immigrants with depression are more likely to come in complaining of a physical problem like a stomach ache.

Tina Encarnacion/UConn Health Photo.

Dr. Sarah Nguyen, a psychiatrist at UConn Health.

Fear surrounding immigration status keeps some people from seeking depression treatment and so does fear of losing custody of a child. Smith stressed that mothers around the country do face child welfare systems that can penalize them for mental illness, but she offered assurances that Connecticut is different. “I think what’s helpful in Connecticut is that our child welfare system is informed about brain science and child development and knows the importance of promoting that dyadic relationship between mothers and children,” she said.

Though financial barriers can keep women out of care, Dr. F. Carl Mueller, associate chair of psychiatry at Stamford Health, urges women not to assume that care is out of reach. “There’s a lot you can do,” he said. “This is not necessarily an expensive proposition. There are short-term treatments that get people out of the darkest places.” He added that treating depression can be essential to avoid lost wages and even job loss. “Depression kills income,” he said.

There is a 50 percent increase in employment among women who get mental health treatment through MOMs, Smith said, citing “a real link between mental health and wealth.”

This is Part 2 of C-HIT’s series on women and depression, sponsored by ConnectiCare.Part 1 is available here.

]]>http://c-hit.org/2018/07/02/poor-and-minority-women-face-widening-barriers-to-depression-treatment/feed/0Costs And Access Still Barriers To Health Care, Survey Findshttp://c-hit.org/2018/06/05/costs-and-access-still-barriers-to-health-care-survey-finds/
http://c-hit.org/2018/06/05/costs-and-access-still-barriers-to-health-care-survey-finds/#respondWed, 06 Jun 2018 02:00:03 +0000http://c-hit.org/?p=268834Iasiah Brown, 25, of New Haven, said he does not see a need for a primary care doctor for himself and his daughter, opting to visit clinics in the area instead of waiting up to two weeks for an appointment at a doctor’s office.

Brown is among the 83 people who said they didn’t have a primary care doctor in response to a health-care usage survey by the Conn. Health I-Team and Southern Connecticut State University. The team surveyed 500 people and interviewed dozens statewide between January and March.

About 83 percent of respondents said they had a primary care doctor, but the rate was lower for African American (78 percent) and Hispanic respondents (75 percent). Meanwhile, white respondents were more likely than the average—at 88 percent—to have a primary care doctor. These numbers have decreased since 2015, when C-HIT conducted a similar survey. In 2015, 93 percent of whites, 84 percent of African Americans, and 86 percent of Hispanics had a primary care doctor.

What residents had to say about their health care, hosted by SCSU student Michael Riccio.

The survey results highlight health care disparities between wealthier residents and those in lower income brackets, and between white respondents and minorities—findings that mirror those of the 2015 study.

In general, white residents and those making more than $50,000 a year were more likely to have health insurance and use it. Those over 50 years old in both groups were more likely to have undergone a colonoscopy. The wealthier respondents more often lived close to their primary care doctor.

But in some cases, those making below $50,000, and people of color, were more likely to have had some preventive care screenings, such as chest X-rays for smokers, screenings for depression, and interventions from doctors regarding their weight.

About 110 people said even though they had insurance, there were barriers preventing them from accessing health care. Of those, 54 cited co-pays, 39 said time or travel expenses, and 17 said there was a language barrier to accessing health care.

For Natasha Gerasimopoulos, 36, of Milford, the problem is finding a doctor covered by insurance. Gerasimopoulos, who is insured through Husky Health along with her son, doesn’t have co-pays for her office visits, but she said it’s hard to find specialists who take Husky.

“The doctors’ offices will say ‘Oh, we don’t take that insurance,’ or ‘We stopped taking it a long time ago’,” Gerasimopoulos said. Or, she said, if she can find a doctor who takes her insurance, the office is far from her home.

Most people, at 92.6 percent, reported having health insurance for 2018. But Hispanics and blacks were less likely to have health insurance, at 80.2 percent and 89.2 percent, than whites, at 97.7 percent.

More people reported being uninsured than in the 2015 survey, when 3.6 percent said they had no medical insurance. Connecticut’s uninsured rate for 2016, the most recent numbers available from the National Center for Health Statistics, was 5.8 percent.

Recent changes to the Affordable Care Act, first enacted in 2010, have negatively impacted health care access, according to Pat Baker, president of the Connecticut Health Foundation.

An example, she said, is a change in the number of state residents who qualify for Medicaid.

“Originally Medicaid in Connecticut covered individuals up to 185 percent of poverty,” Baker said. “What we saw happening since 2015 is that has been reduced to 155 percent of poverty, with the rationale that all those [excluded], about 18,000 people, could go get coverage through the exchange, Access Health CT.”

Instead, Baker said, only 20 percent of those dropped by Medicaid were able to purchase insurance through the exchange. The Connecticut Health Foundation and Access Health CT believe cost was a major factor, as survey respondent Beverly Malerba of Ansonia said. “I can’t afford it, really,” she said. “I wish [health care] was universal, like they have in Canada.”

“What remains consistent is the disparate rate between the connection to care between the majority population and people of color, particularly African Americans,” Baker said.

• 3 percent said they had private insurance, but didn’t indicate how they received it; and

• 1 percent are insured through both Medicaid and Medicare;

One of the barriers to care is travel time to a doctor, especially for those earning less than $30,000 annually.

Half of the respondents made more than $50,000 a year, and 56 percent were women. The respondents skewed younger, with 65 percent responding they were in their 40s or younger, and 29 percent in their 20s. About 53 percent of respondents were white, 20.7 percent were African American and 19.5 percent were Hispanic.

Women’s preventive care results were mixed. Overall, 87.7 percent of women over 40 had received a recommended mammogram in the last year, and 77.4 percent of women over 20 had received a recommended Pap test.

Women making more than $50,000 were more likely to have received Pap tests. But the results for women over 40 who had received mammograms in the last year were split on income levels. Those making $100,000 or more were most likely to have had a mammogram in the last two years (93 percent), but those making less than $30,000 were close behind (89 percent).

Black women were the most likely to have received a mammogram (93 percent) and Pap tests (91 percent). White respondents stated they had received recommended mammograms at 89 percent, and Pap tests at 76 percent. For Hispanic women, the results were 75 percent and 71 percent, respectively.

In dozens of interviews, Connecticut residents spoke of the challenges with their health care.

Like Steven S. Siebold, 44, of Trumbull, who said he pays a high premium for his healthcare—about $1,400 a month.

“It’s terribly expensive for what I get,” Siebold said.

Maria Zhumi, of New Haven, said while she has health care through the exchange, she hasn’t been able to get her 9-year-old daughter on the plan because she doesn’t have a Social Security number. Zhumi said she has been paying for her daughter’s health care out of pocket.

Confusion over her citizenship status is preventing Mayelin Jimenez of New Haven from obtaining health care, she said. When she lived in New York, she paid for private insurance, she said, but canceled that policy when she moved to New Haven in November. When she tried to obtain HUSKY insurance, she was told she had to have been living in the U.S. for five years to meet Connecticut’s eligibility requirements. Jimenez said she must wait until July before she qualifies for HUSKY benefits.

“What if I have an accident?” she asked. “I have no insurance.”

Laurinda Bernardo, 65, of New Britain, said rising deductibles have caused stress for her family. Her 2-year-old granddaughter has mitochondria depletion syndrome and requires constant care. Bernardo’s daughter had good insurance, but it still came with a $5,000 deductible. The next year, the deductible increased to $6,000.

“So that year she ended up paying $16,000 just to have the bills paid,” Bernardo said. “Who has that kind of money just sitting around?”

Barbara Collado, a mother of three from New Haven, has had HUSKY A insurance for around 10 years, ever since she moved to Connecticut from Puerto Rico.

In an interview conducted in both Spanish and English, Collado said her HUSKY coverage helped as she and her children have undergone evaluations for health issues. Collado said HUSKY paid for everything. The experience, she said, changed how she viewed her health, and she began seeking health care regularly at her primary clinic, the Cornell Scott-Hill Health Center.

Collado said, however, that it takes her two buses to get to the Hill Center. When the bus is late, she’s late for her appointments. But it’s worth it to Collado.